UVA NUTRITION SERVICES Low FODMAP (Fermentable Oligo-, Di- and Monosaccharides and Polyols) Diet

What are FODMAPs? FODMAPs are a type of carbohydrate (or "sugar") found in certain foods. Some people may have trouble digesting FODMAPS, especially patients with irritable bowel syndrome, a slow moving gut, or other bowel disorders. This is because FODMAPS are not easily absorbed by the bowel. Symptoms include: abdominal discomfort, distention, bloating, fullness, nausea and/or pain after eating foods containing FODMAPS. The table below lists the names of the carbohydrates that are considered FODMAPs.

FRUCTANS AND GALACTINS POLYOLS

• Fructose • Sorbitol • Lactose • Mannitol • Fructooligosaccharides • Xylitol • Galactooligosaccharides • Maltitol

Fructose* and Glucose Fructose is a naturally occurring sugar found in fruit, vegetables, and honey. Fructose intolerance can occur in people with irritable bowel syndrome and other bowel disorders. Fruits and fruit juices with higher levels of fructose may cause gas, bloating, abdominal cramping, and diarrhea. Glucose is also a naturally occurring sugar. Fruits and juices with more glucose (and less fructose) may be more "intestine friendly". The tables in the following section list which fruits, juices and other foods may be better choices for patients with FODMAP intolerance. High Fructose Corn Syrup (HFCS) * HFCS is an ingredient in many processed foods. HFCS is made up of almost half glucose and half fructose. HFCS may be easily digested by some patients. Therefore, items with HFCS, such as soft drinks, may be tolerated well if they are limited to 12 oz per day and are taken with a meal.

* In some patients, even a small amount of processed fruit juice or HFCS may cause intestinal discomfort and/or ma/absorption.

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Vegetables: Sorbitol ( or sorbose) is a sugar alcohol that is found naturally in fruits and fruit juices. It is used as an artificial sweetener. It can also be found in many "diet foods" or "diabetic" foods (such as diet soft drinks, sugarless gum, sugar-free jelly/jam, and other sugar-free foods). It may also be found in liquid medications. Sorbitol often creates similar symptoms as fructose - especially when fructose and sorbitol are ingested together.

General Guidelines • Eliminate products with ingredients that list fructose, crystalline fructose (not HFCS), honey, and sorbitol on the label. • Avoid sugar alcohols. These include sorbitol, isomalt, lactitol, maltitol, mannitol, xylitol, erythrytol, and lactatol. These are often found in "diet" or "diabetic foods" such as diet drinks, ice cream, candy, processed goods, etc. • Limit drinks with HFCS. If used, drink less than the recommended serving size--less than 12 oz of soda (may help to drink with a meal). • Check your medications for fructose and sorbitol. They are not always listed on the label, so check with your pharmacist or the manufacturer. • Keep in mind the amount of fructose found in 2 apples (or 2 oz of honey) is the same as the amount of fructose in 1 can of soda (note: apples have other nutritional benefits). • Follow guidelines below to choose fruits, vegetables, and other foods that are friendlier to your intestines!

Fruits: • Serving size is ½ cup. • Limit to 1 to 2 servings per day. • Fresh or fresh frozen fruit may be better tolerated than canned fruit. • Keep in mind tolerance may depend on the amount you eat at one time. • Limit concentrated sources of fruit--such as dried fruit and fruit juices. • Avoid eating large amounts of any fruit.

The foods listed as "Foods to Avoid" should not be eaten because of their high FODMAP content. These are otherwise healthy foods.

FOODS TO AVOID IF QUESTIONABLE INTESTINE FRIENDLY FODMAP INTOLERANT FOODS/ FOODS TO LIMIT

Bananas*, blackberries, blueberry, Apples, apple cider, apple juice, Other fruit juices or drinks, sugar- grape, grapefruit, honeydew, applesauce, apricots, cherries, free jam/jelly, dried fruit, canned kiwifruit, lemons, limes, mandarin dates, grapes, lychee, mango, fruit in heavy syrup, other fruits orange, melons, oranges, papaya, peaches, pears, pear juice, plums, passionfruit, pineapples, prunes, watermelon raspberries, rhubarb, strawberries, tanqelos

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FOODS TO AVOID IF QUESTIONABLE INTESTINE FRIENDLY FODMAP INTOLERANT FOODS/ FOODS TO LIMIT

Bamboo shoots, bok choy, carrots, Artichokes, asparagus, some beans Avocado, corn, mushrooms, cauliflower*, celery, cucumber*, (baked beans, chickpeas, kidney tomatoes, other beans eggplant*, green beans*, green beans, lentils) beetroot, broccoli, peppers*, leafy greens, parsnip, Brussels sprouts, cabbage, pumpkin, spinach, sweet potatoes, cauliflower, fennel, garlic, sugar white potatoes, other root snap peas, leeks, soy products, vegetables okra, onions, peas, shallots

Other Foods and Food Additives:

FOODS TO AVOID IF QUESTIONABLE INTESTINE FRIENDLY FODMAP INTOLERANT FOODS/ FOODS TO LIMIT

• All meats • Honey • Limit products with HFCS if • All fats • Flavorings with fructose or sorbitol symptoms still continue • Yogurt and hard cheeses • Desserts (ice cream, candy, cookies, • If you experience symptoms • All eggs bars, popsicles) sweetened with with lactose, try limiting milk, • Aspartame (Equal® and fructose or sorbitol cottage cheese, and other Nutrasweet®) • Cer eal or other processed foods with lactosecontaining foods (see • Saccharin (Sweet 'n Low®) sorbitol or fructose on the label Lactose Intolerance handout) • Sucrose (table sugar) • Sherry and port wine • Glucose • Sweeteners such as sorbitol, • Maple syrup mannitol, xylitol, maltitol, and isomalt used in sugar-free gum, candies and mints

Medications: Many liquid medications and some personal care items may contain lactose or the sugar alcohols (sorbitol, mannitol, xylitol, maltitol, isomalt). Examples include: liquid pain relievers (including liquid gel caps), cough medicines, and cough drops. If possible, choose a tablet or caplet form instead of liquid medication. If you have eliminated FODMAPs from your diet and are still having symptoms, talk to your pharmacist to see if any of your medications contain lactose or sugar alcohols.

Additional Resources: Visit: www.Ginutrition.virginia.edu o Go to Nutritional Issues in Practical Gastroenterology o Scroll down to the 2007 articles: "Clinical Ramifications of Malabsorption of Fructose and Other Short-chain Carbohydrates"

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